How progress on AIDS shapes the road to universal health coverage

Progress on HIV-AIDS treatment could indicate a way forward for the universal health coverage movement. Photo: Jodi Hilton

At the turn of the millennium, only 625,000 people worldwide had access to HIV treatment. Millions died slow painful deaths because lifesaving drugs weren’t available to those that needed them. Cost was the major barrier and the stigma, discrimination and exclusion associated with AIDS was pernicious.

Driven by people living with HIV, grassroots activists, and then politicians got on board with the message that people had a fundamental right to lifesaving antiretroviral treatment. This pressure led to an extraordinary reduction in the cost of drugs, which meant governments could afford to exponentially increase the number of people receiving treatment.

According to the latest UNAIDS report, almost 21 million people are now on treatment. This is one of the greatest public health achievements in history, and although universal access has not been achieved, there is now a roadmap towards reaching that goal by 2030.

This World AIDS Day, while recognizing that we have made great progress on tackling the virus, there is still much more to do in terms of realizing the right to health. Everyone living with HIV has a right to access treatment, and to do that effectively governments must prioritize building health systems that provide universal access to all health services.

The movement for universal health coverage (UHC) has grown dramatically over the last few years, in some part because health shocks like Ebola and Zika highlighted that the global health system is only as strong as its weakest parts.

The renewed movement for quality health for all is reminiscent of the effort that changed history on HIV. A groundswell of support from civil society, backed by political leaders who have put health first, has ensured that more people can access quality and effective medicines, vaccines and diagnostics.

Thailand is a great example of leadership in the field. Recognizing HIV as a major public health issue, the Thai government successfully established HIV treatment services in the national UHC system. These services were diverse and comprehensive, including maternal, sexual and reproductive health services. In just seven years, people with access to treatment grew from 40,000 to more than 250,000.

Linking HIV treatment and prevention to UHC also enables us to take a hard look at the pervasive inequalities in access to services. Marginalized groups, including injecting drug users, men who have sex with men, transgender people and sex workers, are more vulnerable to HIV infection, which means there is a need to urgently scale up prevention, testing and treatment services for these groups. Also, overall, women and girls are disproportionately affected by HIV: globally, AIDS-related illnesses are the leading cause of death for women of reproductive age.

By improving UHC, countries can simultaneously address the needs of women that may otherwise go unseen. Women seeking HIV treatment may also need maternal, sexual and reproductive health care. A singular programme could overlook the intricate and overlapping health services that women and girls require. Promoting UHC as a way to prevent HIV, and treat those who are already living with HIV, provides the best shot of simultaneously achieving multiple goals.

Creating a stronger partnership between the HIV and UHC movements has the potential to drive the step change that is needed to achieve the 2030 Agenda’s health goals and targets. This December, the UHC Forum will take place in Tokyo, and governments, global health experts and civil society will come together to develop a new roadmap for reaching UHC.

As we reflect on the movement that turned the tide on the HIV epidemic, it is time to integrate HIV services into UHC and make good on the ‘health for all’ promise. Together we changed the course of an epidemic, now it is time to change the system so that no one is left behind.